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Dissemination Type

Date

Description

Emphasis Area(s)*

Number Reached (numeric value)

Additional Information (Optional)

Choose an item

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Outreach Events and Training for non-OSHA Staff: Alliance Program participant or OSHA participation in events which includes speeches/presentations, exhibits, roundtables, conferences, informational webinars or other meetings or training in support of the Alliance or an OSHA initiative.

These tables are best viewed on tablets, notebooks, or desktop computer screens.

These tables are best viewed on tablets, notebooks, or desktop computer screens.

Training Type

Date

Name/Title of Trainer

Training Title

Audience: OSHA/ State Plan/ Consultation

City

State

Emphasis Area(s)*

Number Reached (numeric value)

Additional Information (Optional)

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Alliance Developed Products

[List all Alliance products developed by the Alliance Program participants during the timeframe of the reporting period. If none, you may delete this section.]

Report prepared by: [Alliance Coordinator, title, Office, date].

*Please Select From The Following Emphasis Areas: (Emphasis areas are tied to OSHA's Operating Plan, DOL's Strategic Plan, and agency/departmental initiatives; they are updated annually. Use only Areas listed below. If none apply, leave blank. More than one can be included; please input them in alphabetical order.)

Agriculture

Beryllium

Construction

Emergency Response/Recovery

Fall Prevention

Fall Stand-Down

Health Care

Heat Illness Prevention

Hispanic/Latino Workers

Oil and Gas

Recordkeeping/Reporting

Safety & Health Programs

Safe + Sound Week

Silica

Small Business

Temporary Workers

Telecommunications Towers

Trenching

Walking-Working Surfaces

Young Workers

PAPERWORK REDUCTION ACT STATEMENT

OSHA's Alliance Program provides the following agreement template to assist organizations preparing an initial, regional Alliance agreement. Under the Paperwork Reduction Act, a Federal agency generally cannot conduct or sponsor, and the public is generally not required to respond to, an information collection, unless it is approved by OMB and displays a valid OMB Control Number. Use of this template is mandatory. The template ensures that alliance participants provide required information about potential alliance activities to OSHA. OSHA estimates employer burden for the completion of this collection of information is 8 hours. This estimate includes the time for reviewing instructions, determining goals, and developing objectives for the agreement. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to OSHAPRA@dol.gov or to OSHA's Directorate of Cooperative and State Programs, Alliance Office, Department of Labor, Room N-3662, 200 Constitution Ave., NW, Washington, DC 20210; Attn: Paperwork Reduction Act Comment. (This address is for comments regarding this form only; DO NOT SEND ANY COMPLETED TEMPLATES TO THIS OFFICE IN THIS MANNER.)

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